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tv   Key Capitol Hill Hearings  CSPAN  May 15, 2014 6:00pm-8:01pm EDT

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with that, it is my great pleasure to introduce our other partner in these activities, one of my favorite neuroscientists neuroscientists -- almost neuroscientists by now, who is a member of the house of representatives from philadelphia, one of the most places to be for him i might mention. congressman photog is among many in the ranking is a committee that the anas asked and the department of energy science programs, national institute of science and technology he had a way of other important things that could ease. he is among other things one of the greatest supporters of science in this country and he
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is a guy who had the idea for a brain initiatives and i love that about him. with great pleasure, i give you chaka fatah. [applause] >> first of all, let me thank each of you for coming. this is an extraordinarily important and i hope you will find it an enlightening briefing on one of the major challenges we face. there were hundreds, well over 500 related diseases and disorders, but posttraumatic stress is a challenge at the very forefront of the issues. i know you have heard from the general a significant percentage. 40% of our angers holger is over this period that the nation has been at war. their injuries are in the post
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traumatic stress. so whether it is in terms of the work that one mind is focused on, which has been at the cutting-edge. i know you've heard about it today so i won't repeat it. i want to make room for other guests. i want to say a few things. i want to thank the dana foundation and thank alan for the gracious introduction. i found these have helped build the kind of felt that can science we need for moments like yesterday where we had the largest increase here in the narrow science space, taking the national science foundation and investment in this area for the next fiscal year to be well over $505 million.
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.. a very important initiative, but it is just part of parcel of what we need to do. so this briefing, like the others, about having a currency for knowledge so that we can help move this bipartisan consensus forward in no way in which we can really make a contribution.
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to will stop there. visit the national launch of the museum. i have been around the country looking at the activities and a variety of a relapse. i am convinced we are at a tipping point and can make real progress. what we need to do is understand that and then balance it, the editorial in science magazine. we need to seize the neuroscience moment. [applause] >> as a narrow scientists i do have to of think the congressman for the comments, the inside to try to make sure that, in fact, these large frame initiatives going on around the world are actually being coordinated. while you were making reference to, i just wanted to make sure
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that everyone knew because it is really an important milestone in psychiatry and behavioral neuroscience. the full bios are in the program . [applause] >> good afternoon. thank you very much score letting me give an overview about cognitive process therapy. this is one of to their bees that international guidelines have given credence to being best practices. i think it is imperative that we dispel some of the myths that are out there that ptsd and ptsd not treatable off, that it is a lifetime disorder faugh. it is critical that we understand that all of those go
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through, there are lives know whether it be horrible car accidents or the son of a loved one. we don't expect to be miserable for our entire lives, but there is something about being a warrior that makes people think this is something they will suffer with permanently. dramatic stress bella as significant a love @booktv enough level of the person is impaired. we have to understand that we can and treat them and help them get better. we do have one of the treatments . this therapy is sexually quite old traded 1988, survival of sexual assaults. then we more did as time went by and began comparing it to the other treatments. it also received gold standard. and then we morphed again. finally into a veteran military manual that we have in use today throughout the veterans affairs
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and the part of the fence. this is a treatment design no matter what the impact trauma was. we have used it in china for victims of the hon. earthquake or it covered the school. reeves said of the world trade center for the people who had to clean up. so, again, dispelling the myth that this is just about warriors i just want to take a second to talk about what the theory is behind it. again, why we need something that, perhaps, is cognitive in basis. we'll organize our thoughts as our governing principle of how we interact with the world. you're scheming guided whether you just to drink water or diet coke because you either needed the caffeine or addictive or were trying to hydrate better. but those were rules. where do they come from? from your family, your doctor? your nutritionist? you have schemas and rules that guide most of what you're doing
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in your life which are developed through interactions with your peers, parents or religion, cultural group, the military. the problem is is that we often function on really that if i go out and do good everyday good will, in toward me. they're is a small problem with that. what happens when i bad event happens to someone did things that have been good? what happens when your best friend is killed and you were the officer in the unit? you thought you did everything right, but johnny's dead. it is very hard to think that you have done good, but he's dead. so what do i do? and must have done something wrong. and by doing that something wrong i caused his death, and now i will suffer for it. and what we find is that they completely change their entire schemas about the world, and it becomes not just i did something wrong about johnny. it is, if i'm in charge of
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things, i will make mistakes. things always go wrong. i cannot trust my get. i cannot trust my opinion. the world is not safe anymore. i can't even trust other people. i cannot close to people because they will die. we see these massive alterations in the card mission as they go through their lives the become worse and worse and worse, and then the circle of life gets smaller and smaller and smaller. they don't go out anymore. they don't socialize. what happens? depression in sues. often we see substance abuse. now we have people who have got multiple mental health disorders, when if we treated that first initial all the rest of it would not happen. and you see are risks for suicide and other horrible things going up. so what does it look like? it is actually quite simple. it started out as a tall session therapy for him. we first wanted to teach them about the connection between the
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thoughts and feelings. slow them down enough to understand. talk about how you have been impacted by the trauma. what are you telling yourself about this event having happened to you? and then we ask them to write about the trauma. and for a long time people said, not going to trauma therapy because you'll make me talk with the trauma. how many times i go saying special forces will come into my office and say, i can't talk about the trauma because i signed a statement saying and what not. well, you know what, and cognitive processing therapy we have shown that it works equally well without ever telling the folks from the story. there is no excuse for not getting help if the reason is you don't wanna tell your story or you feel you cannot. you can still get better without it by focusing on what it means to you that happened and not what happened. we then begin to get through challenging these assumptions.
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let's look at the world, whenever you have been telling yourself. i teach you to be a better therapist. we move them forward. we talk about these five areas that i actually critical in terms of posttraumatic stress. use the safety. trust. power, control, self-esteem, and tennessee. we ask them to revisit the impact and see what is changed. we thought this was a nice, perfect package. will we began to see is maybe not. some people may be need a little bit less. some people a little more. the first thing is we had to prove that it worked overtime because people would say, oh, yes, that there be works well for how long. we did it and five plus years. scientists in the front row can vouch for how many do 5-year follow-up on any mental health issue. by being able to look at these two therapies, we have looked at
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these two treatments. some of these folks were ten years later. they got better and stay better. that's all we know. if they go through these treatments there will get better. less talk about how much they need. startlingly it is not even 12 sessions. the majority of people will reaction looked at two got better when and stop forcing them because it is a research study, let's look at how fast you get better. you can reach maximum improvement. people getting better and eight, nine, ten sessions. that's all are asking of someone to get better from posttraumatic stress. still, 18 sessions of there be compared to a lifetime of distress. the hard part is that they have to be willing to do the work,
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and that is the hard part. let me mention veterans, something that is important. can they work? in the answer is absolutely. in the work in vietnam veterans? world war ii veterans? there is nothing that makes the population different. treatment and is usual, non evidence based compared to using this treatment with vietnam veterans. look at the difference. if we ask them to do this they did much better. as the general mentioned, would like to talk about focus with cbi. individuals to go through a traumatic brain injury incident cannot do posttraumatic stress work. maybe the memory for the incident that caused it is too fragmented. maybe there are two disconnected, to of base in their attention and concentration.
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we actually admitted patients into the program with mild to moderate, and lows of the year ddi and i am thrilled to tell you that they did fantastically well, but more importantly the low and severe td i did better in cognitive therapy than those moderate. the sylmar knew they had a problem and were invested in working through their problems in getting better. i have a lovely story about a and man who went through at least 13 different events before vienna penetrating blast injury that really shredded most of his face but also ended up taking his life from them. this guy was addicted to pain bills when it came to my clinic, and by the time he was done without there being no longer had ptsd, no longer was on the spin bills of all, lost his leg seven months later, and still did not have ptsd. we have been in contact with them. he still does not have ptsd. and he is gone severe tci in its
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history. so the last thing i want to talk about because i know we need to save time for the next presentation in questions is what are we doing about it? okay. you know we have with their big works. we're redoing the charter of get it out there? well, we are going now throughout the viejo, threat the department of defense creating trainers of the we have more people who are absolutely skilled and looking and having them go out and train multiple conditions in different settings on how to use these there peace. making sure those conditions are trained with ongoing consultation. the worst thing you can do is train someone in that today training in expected to go out. monthly, weekly, consultation with an expert to help make sure when that difficult case walks in the door al i work with that individual estate true to this model. don't go back to whenever there pierre was doing before that was
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not effective. we are doing this ongoing training of trainers and ongoing trainer of therapists. i just artwork where we will do an online training cahuenga. of funding to look at online train the trainer where we can create more trainers quickly and then have them continue wonder and online interactive way to make -- maintain their training capacity so we could have more people making sure we have therapies available at all times we do need to address ptsd. does it work? i want to point out these coor's these are the first two cases therapist's ever saw using cognitive processing therapy. people who are vietnam veterans, people from gulf war one and then our young oes ally f.
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these are therapists who have never seen this therapy before. the improvements are the same as what we saw in many of our randomized controlled trial which shows us that if you cheat -- teach a therapist added do it well and give them good consultation in right out of the gate they can be an effective therapy for treating post-traumatic stress and a multitude of settings, whether it is inpatient and outpatient, residential setting. in addition, i change numerous clinicians who have actually used this downrange. i note they're pursue have used this in afghanistan, a rock, and five sessions in the span of about two weeks to get someone functioning in being able to stay in the military. one of my favorite stories, from afghanistan because he wanted to stay in the military. they were able to get him out to me with the contingency. we treated his posttraumatic
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stress at the end. he no longer had ptsd the really fine a sworn affidavit saying he did not have ptsd. a ticket. he was sent home, and within three days was on a plane back to germany to begin reintegration with his unit for. that young man is still in the marines today functioning as a warrior because that is a career that he wanted. he does not have ptsd. i really want to get across the message that it is a live debilitating event only if we allow it to be. if we remove the mess, we can get people care that will allow them to continue in a live trajectory if they wanted to have in the first. whether that be in the military or any other avenue side. and with that i would like to close out by pointing out some of the final figures of comparing the different types of conditions, men and women -- let's get away from the myth that women can't go through these treatments. they can be treated equally
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well. all of them quite effectively in terms of the outcome. a very large sizes. and then again we know that depression comes so high without posttraumatic stress. the treatment trees that oppression equally well with the posttraumatic stress. where are we going? obviously we need to keep doing work on a group and individual therapy. so many clients coming in, we have to be a will to provide more group therapy. looking a lot at another glowing evidence-based treatment and doing a lot of work comparing therapy and prolonged exposure, as 17 sites that because we want to look at which therapy is the best therapy for which person so that we can actually get person's specific in our recommendation when someone is coming into our clinic. well, based on who you are and what you are saying, this therapy is the best fit for you. we are looking at severe mental illness. individuals come into our
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planning to happen to be schizophrenic, bipolar manic. when they come in the a little extra help, can they do well? we are looking at that, and it is beginning to show that they do quite well. the therapy with adolescence, underserved population in our society and actually doing really well. also looking at other countries. publish data on cognitive processing therapy in the democratic republic of com and -- condo. we have there been seated not even have a college degree learn how do the therapy. getting the training and in the ongoing consultation. finally going to people's homes, they're smart phone to my pad, and being able to work with them in that steading instead of dragging him into a stunning summer where they feel very underserved or perhaps isolated by looking in all these people that don't look like with that will stop and be ready for
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questions later. thank you. [applause] >> data is tremendously impressive. have an array of questions for you later. i hope everyone else. our third speaker is dr. joanne, a professor of psychology and psychiatry and director of the program for anxiety. >> thank you. i am delighted to be here today, especially because i started out of capitol hill as an intern and that a legislative assistant before it decided to go to graduate school. be careful. okay. let's see. so i am going to start by providing the context. we have to evidence-based treatments. how did we get here? why were they not used for
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vietnam vets? used for world war ii survivors? i think it is important to understand the context. i think it will inform how we go forward. treatments which are not disseminated and used as widely as the could be. i'm going to start here. when i was a graduate student, about 25 years ago there were no evidence based treatments. i was handed a file about that large. it was a ptsd patient, woman who had a very horrible experience of what missing her former husband murdered boyfriend. we did not know how did trader, but i happened to be doing a rotation on a burn center. posttraumatic stress symptoms. i agree to take the patient. i can certainly tell you, she would be treated much differently today. i happen to be lucky because i had a supervisor who was sort of on the right track.
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and you see now, wearing an head mounted display. i will and talking about using technology and virtual reality and show you a couple of the los there we go. so why did it work for you and not me? i am pressing the arrow. the other arrow. while they are fixing that maybe someone can come up here and show me. what i am going to do is talk about exposure therapy, who it's for. abcaeight. will just keep talking. i am going to mostly start this -- okay. are we going?
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okay. here we go. while they're figuring that out among going to fast floridian start the story, september 10th 2001 the data for the world trade center. where were we? well, about a year before that the major proponent of exposure therapy -- why? okay. yeah? okay. fast forward. we can skip that. okay. there we go. where were we? there was preliminary evidence fur want evidence based treatment, prolonged exposure therapy. one approved medication, as a loft. the expert consensus guidelines had first been published a year-and-a-half before recommending this treatment. let me talk -- let me say a few things. the term expert consensus,
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evidence based, and first-line treatment were very new in psychiatry. our education until that point had pretty much been nominated by other theories, but there was not an emphasis. when i started using the term and said i want to start an evidence based trauma treatment plant at the world trade center, people kind of looked at me like i had three heads. what does evidence based mean? and science in general, psychiatry, but we are talking about is treatments that have been studied in gold standard treatment design. it would be a randomized controlled clinical trial comparing different treatments with different trauma populations and showing that they are effective. year results are assessed by reliable and valid measures. what the point of saying this is, there are very strong pieces of science underpining these treatments. can we go forward?
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i was expecting to be able to just go through my slide to make points as needed. i apologize. keep going. okay. keep going. okay. jumping forward now to 2008, the first institute of medicine report was commissioned looking at the evidence for ptsd treatment. it concluded that there was one psychotherapy exposure therapy and to forms of it to my cognitive processing therapy and prolonged exposure therapy or various expose it their peace. the evidence was sufficient to conclude that these treatments were effective in treating patients. so in the back of your mind, why are we using them more? keep going. so the evidence is across. we have at least 27 randomized
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trials across multiple trauma population, a veteran, female assault survivors, mixed trauma, car accidents, muggings, refugees, earthquake, the world trade center. excellent. again, i don't want to belabor the point too much, but not only in the united states but worldwide. there is one example. you know, the national averages board also concluded that exposure therapies were effective treatment for ptsd. and one of our i guessed professional groups also made us draw the same conclusion. they're is a laundry list of organizations around the world that have drawn the conclusion that are respected. okay. so i'm going to talk a little bit about what exposure therapy has delivered is and then i'm going to talk a little bit about -- and going the show you video and then talk a little bit about what i think some of the
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obstacles are. i think that is particularly important in your role as public policy here on the hell. okay. so this is also a very old treatment that goes back at least until friday if not before it's based on conditioning, which are missing mostly everyone in this from took site 101. and it is a form of behavior therapy in which you describe your thoughts, feelings related to your situation or event. here we have a systematic a little person. they will be shocked. we have our ob permission. and there will also be shown a light bulb at the same time. the light bulb is a mutual stimulus. we should not be scared omer round light bulbs. certainly the mild shock is aversive. what happens is -- well, okay. here you have -- for get the
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shock. we will do startle. what happens is you pair the startled -- the acoustics -- with the white. over time you take away the acoustic. the light bulb itself is going to be a condition to q fear. when you see the light your going to jump. is reliable across humans and animals up and down the fiber genetic scale. next slide. all right. keep going. made the point. okay. what do we do in exposure therapy? it is essentially extinction training, that terrible phrase. it sounds like the treatment is unpleasant. we probably need to rename the treatment actually, but that said it is extinction training. we are essentially taking a patient and asking them to come and -- in this case we need to talk about the trauma. we ask them to go over the trauma as if it were happening
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again over and over again until they capitulate to it. in other words, until all of those accused of fear no longer create fear. does not take as long as one might think. typical controlled clinical trial is about 12 to 16 sessions recently have studies showing that people get better in many fewer sessions. however, because part of having ptsd or ptsd is avoiding -- next slide, please -- is avoiding your trauma lot of people have difficulty engaging in it. this is -- i think we can probably skip this. this is a picture from the world trade center. actually s simulation to make the point that mutual situations and in real life become accused of year. most of us are not afraid of walking down the stairs unless you have fallen at a really bad accident or if you were at the
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world trade center and you were escaping that they not knowing what was at the bottom of the stairwell, would you be able to get out, survive. guess what? it's no longer neutral. psychologists and psychiatrists would often use a technique for relaxing patients in which you have them walk downstairs, close their eyes, and gradually imagine that the end of the walk down the stairs there will be more relaxed, go to a happy place. can't really do that anymore. in fact, we might be introducing a cue to fear. yeah. there we go. a way that we think about posttraumatic stress, which is so different than 25 years ago when i was interning in some academic theories prevailed, it is a disorder of fear. learned avoidance is a big part
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of it. the puzzle is at near-record phobias to be the person who, whether you're at the world trade center, served as a warrior and a rocker afghanistan or in a car accident, there are a common set of features. we learn to fear what our traumatic event was, and then on like with phobias we generalize it which means that we come back from whenever our situation was and are likely to be afraid of flying, be afraid of going in bridges and tunnels, likely to not want to listen about bad things because those few cues to whatever the particular trauma was have no generalized and it leads to what the doctor was talking about earlier where patients start to narrow their world more and more and more. so a scenario as well as our first responders and others, they don't want to go out to dinner with their wives on saturday night because they are afraid that the noise bothers
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them, have aroused among worry that something bad will happen. if they do go out they have to sit with the back against the wall so that they can look down and see what's going on around them. what's happening? their brain is still processing their trauma and telling them that something bad will happen. and so they are kind of booking for something bad to happen. next slide. just go back real quick. coupes. well, you were going to see a slide that said that the fear responses hard wired, and much of what happens, you know, with pds is in the brain and emotional centers, particularly the men below. we'll have time to go into that, but i want to make the point that there is lot of, at this point, preclinical evidence for neuroscience showing -- outline the fear circuitry in the brain was not only helps us with the available treatment but will also help us going forward developing -- hopefully dare i
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say a cure. i know is not used and psychiatry much, but we have to change the thinking there. we talk about cures for cancer. we should talk about cures for posttraumatic stress as well. as i said, there is lot of evidence emerging from preclinical colleagues that would suggest that that will be so -- probably sooner than we think. let me think. can i remember what my next slide was? the other reason i was mentioning that point is going back to the way we view mental illness, psychiatry is that there are a lot of people who still think that they can bootstrapped themselves. get over it on the marin. work a little harder and what have you. i think the other point is talking about how this is a brain based fear related condition which leads us simply to understand -- i'm sure no one in this firm believes it. it is not a lack of well. it is not a sign of weakness.
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it is not sign of a character failing. it is command become a condition that is eminently treatable. abcaeight. so perfect. abcaeight. so what does exposure there be accomplished? we help our patience process their memory in such a way that they can reorganize it. talking about schemas before. reorganize it and understand it is something that happens in the past that is not happening again and then treat them up to go on and go for it. go out to dinner with your spouse, significant other, whomever, your friends. it involves situations where we go over and over what happened as if it were happening again. this is our part for patients, but nonetheless when we get our patience to engage the first time a state. and they get better and they get
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better in very few treatment sessions. i was actually treating a very high level member of the nypd not so long ago and point that out only because ten years after the fact the officers, i think, whether they are police officers, firefighters, or soldiers tend not to get treatment. we have a site at cornell. a sneak down the c.s. in any case, where i'm going with this is, this man was very involved in the world trade center efforts and coordinating things that day. and then keeping the city save thereafter. well, he developed ptsd and a drinking problem, and is a divorced, left the police department. i am not saying anything about any one particular individual for. it is sad the number of people.
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anyway, the point is he got better. i wish i had known about this sooner. why didn't i know about this? why wasn't this offered to me? i did not think i could get better ten years later. that was the emotional process. effective across trauma populations, effective for soldiers returning from iraq in afghanistan. police officers and firefighters. 9/11 is still a big public health problem. about 16 percent survivors of the world trade center still have posttraumatic stress disorder. it is treatable, but a pretty much does not go away unless you get treated. offs now i am going to and move
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sideways a little bit. exposure therapy requires telling a trough as if it were happening again and generating it from your imagination. avoidances part of posttraumatic stress. we have a conundrum. how do we get people to engage? following 9/11 we understood, evidence based treatment, exposure therapy, medication as necessary, but we knew and that it was not perfect. we had much less knowledge. we knew it would not be effective. what could we do to enhance the experience in such a way that people could engage in the treatment more easily. if you think about the day-to-day experience he spend all your time thinking in of the sensory dimensions. you see things, your them, small and, feel them. we thought, well, why not try and create virtual reality
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simulation? there had just been at key series published by then someone unknown to me who is now close colleague taking vietnam veterans who had failed, if you welcome a multiple treatments over many years and showing that they could achieve symptom reduction with the virtual simulation of the non. i am going to jump forward now. piggybacking on her work that suggested these forms of treatment were, indeed, a potentially effective we now have a multi sight clinical trial going on comparing virtual reality, forms of exposure therapy for our warriors returning from iraq in afghanistan. you can see, at this point we now have -- when i started with the world trade center, we had to run this on the workstation.
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it was a very limited program depending on how much time there is also you that. we're all more interested in combat-related ptsd. today we have -- in the alum started this back in 2007 there were two scenarios. the city's scene with the patrol. you could only really have one soldier in the patrol, and one convoy. that was a couple of days ago. my colleague launched a version with 14 different scenarios including some areas. you can see here we don't use all of the available elements. as i said earlier, when we undergo trauma we learn accused to our fear. a common one would be a fly over . if you go to the next slide please.
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okay. this just makes the point, using virtual reality. the world trade center. okay. there we are. this is going to show young man it received virtual reality treatment. go to the next. there we go. talks about treatment and shows you how we use it. then i will talk about some of the obstacles to care. would you like me to help you? it did work.
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[inaudible conversations] [inaudible]
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[inaudible] >> it took a 15 year-old boy. it struck home. i went home and don't think i knew. my wife will tell you i never smiled. she sent me to the store when i first got back. we weren't walmart. can you go to the store? short. there were like 50 kinds of toilet paper, and i could not make a simple decision. i almost said a nervous breakdown.
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is just not -- on not used to it it was such a hard decision to make. i talked to a psychiatrist. that did not want to hear that. that did not want to your the symptoms of post-traumatic stress disorder. you have to be kidding me. it was the last thing on the plan a one the year. sessions up 30 minutes to an hour. grab the comptroller. you can't see a doctor. at intermittent intervals they introduce explosions and gunfire
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. it is tough. it is tough. you have spent so much time trying to avoid thinking about the deployment. there dredging up these memories it's difficult. i think it was a great idea for them to put you in that format. is better than sitting there. >> so, this shows you, so, what we do for patients particularly who are reluctant to engage in treatment we think. it is an empirical question because the direct comparisons of prolonged exposure the virtual reality is poser are going on right now. ours is one of the major ones and then there is another one up in the pacific west.
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by the way, our's involves a site in new york where veterans, national guard, active-duty can go. the national interest the center we can also look to see how the treatments to with active duty as well as veterans. you can keep going. there is an evidence based for both forms of exposure therapy. it is just not clear to as yet have the treatments will fare with different from the populations and within the trauma population such as combat related ptsd and two will be better for it. one does would be that this woman's treatment will work particularly well. you can bypass your willful avoidance of your problem and all of the stimuli that you need to make you welcome and to call up your accused of year, process your experience, and get better,
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master it, and move on are available on the virtual world. keep going. i want to end. i know i don't have much time left. what said make the point. i started out by showing there is pervasive evidence from multiple governing bodies, scientific organizations that have concluded these treatments are effective. why don't more people get them? since i am here on the hell i just wanted to end by pointing out, first of all, there are myths. engaging people directly with their memory is cruel and we should not do it. people are reliving it with their symptoms. interested imagery. when you least expect you have something pop into your mind that is related to your trauma. we are not asking people to do something of their brain is not already doing. we are introducing. can be done across all traumas,
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not just discreet ones. police officers who continue to confront trauma regularly. warriors and veterans. keep going. okay. keep going. okay. some of the major problems we are having really have to do with our systems of health care delivery. there are multiple and pediments, geographic impediments, telemedicine is helping with that, but it is still very hard to do because i may be lices in new york but i can't practice in new jersey because i don't have a license. if someone from for dixon was to be in a treatment study you have to get to the york. as i said, with the earlier misinform consumers, health care providers, and then stigma and prejudice. there is one slide.
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keep going. keep going. okay. well, what this shows is, i happen to be here in town for a meeting about for five years ago they're is a huge pink ribbon hanging from the back of the white house. i thought to myself, wouldn't it be great if we had something similar for ptsd? our government leaders got behind breast cancer. twenty-five years ago that was not the case. do it for our warriors, veterans , cops, fire fighters. my point is that i think it is going to take embracing that there is stigma around mental health. i know we're at the tipping point, but we have to keep pushing and pushing that message whether its particular concrete or others, and nothing that will then in turn make a huge difference of that that cup
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doesn't show up in my office ten years later another veteran doesn't lose his family and the developed a substance abuse problem. thank you very much. [applause] >> okay. if our panelists will just take their seats. congressman. [inaudible] they have come out showing that young people being raised,
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challenging communities and our country have stress similar to if they lived in a war zone. you know, so gun shot, other activities, on a regular basis. even now we're talking about wars, and the wars and we also have civilians. we have seen a number of studies now showing that kids have higher stress tested in war zones in terms of their sense of trauma. >> the traumatic brain injury, posttraumatic stress, to honor 65 dozen soldiers a been diagnosed with traumatic brain injuries is the beginning of the 13 year war. traumatic brain injury. americans have dramatic brain injury every single year, every single year.
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i have seen, although it is hard to estimate, as much as 8% of the population will suffer from posttraumatic stress. these are huge problems not just with a military bus civilian society as a whole. >> go ahead. >> epidemiological studies do show that in urban areas there are often people exposed to multiple traumas before they reach adulthood. there is chronic stress. >> 8% of all individuals living in the united states will have posttraumatic stress disorder in their lifetime. one in five women will be subjected to an attentive are complete child sexual abuse. one in seven boys will be subjected to an attentive or completed sexual abuse. one and five women will be subject to enter into or completed rape. neglect or abuse of children results in over 20 billion in direct cost to united states
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every year. 40 billion in indirect cost due to the problem that once someone is abused you have the social welfare system, juvenile justice system, adult court system. all of these things are happening duce that interpersonal assault. when you add into a tvs and motorcycles and the other types of trauma that one can experience, you're talking about hundreds of billions of dollars every year due to a traumatic stress, especially entreated traumatic stress that has nothing to do with the military. >> of want to make one other point because it came up in both presentations. i don't at the de. that upsets a lot of people that i as a liberal arts major and renaming this posttraumatic stress. i have done that because of two stories that were told the pier. dividual who waited to get help and tried and other symptoms of drugs or alcohol which is will we see with a large number. they don't want to be told they have the disorder.
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don't go to the people who went in, cat help and say is the de important? it wasn't. people that and not getting help because we continue to call this a disorder @booktv nothing before too long we will be able to understand the biology and what happens in the brain and it will no longer be a disorder but an injury that occurs to the brain. injuries can be healed, but this desire to continue to call and the disorder, i think, is a barrier to care. >> these are rather different treatments. aviano which treatment to use? pick one? is there some kind of marker that you can use to tell you which treatment you ought to be using? >> at this point we recommend patient informed choice. you tell people what the two options are and give them informed choice. that study did one minor thing which suggested that people hire
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on fear and avoidance did better. people that were higher on guilt and self plan did better with cognitive therapy. the whole reason we are doing the 17 sites head to head is to answer exactly that, and we will be done in three years. i will be back. >> we have another one. are you ready? now much better is better? when i saw the curve of pre and post treatment it did not go to zero. how much better is better? what can we hope for when these therapies are used? >> i can stay at -- can say a study we just published using virtual reality with a cognitive answer, and other words, medication which is actually a real purpose drive. basic science showing that it enhances learning. 80 percent remissions six months later. and --
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>> permission as in zero? >> pretty much. no symptoms and in addition as rated by an independent assessor , the patient shows no impairment, occupational or social fund -- ptsd affects how we get along in the world. typically people are coming in saying i did not get promoted we are reaching the point where we can talk about people going into a very long-term mission. maybe not so far from that we will be able to talk about cures as well. >> my only thing is, as policymakers have to understand a couple of things. these things take time. when you're looking at the ability to do this city to be looking at a couple of things.
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first, do you have trained people who can do these therapies? second of all, are they given the time to do it? ready given the time to execute the protocol? and that is a huge issue here. that is a huge, huge issue that we really need to keep the spotlight on. if we don't, we can get ourselves in this situation is that our very, very poor. that is when you get into the polypharmacy in the other things that i have seen. >> people want things quickly and it does, indeed, take time. >> are to deploy some one midway through their peak. it is critical we can keep them in that central location for summer between eight and 16 weeks. to further answer your question, 70 to 80 percent of individuals going through these therapies will get better and stay better. what does that term mean? typically it means that they don't have symptoms enough to be significant for the disorder.
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will they have some symptoms? absolutely. for those of you who have gone through any type of major event, you will feel sad, have problems sleeping. we are not saying there won't have something. a cure does not mean not caring. a. georges means that it does not control your life anymore on its terms. >> okay. now you have all these policy types captive. seize the moment, as we say. >> you have to ask the question. if you have therapies, why aren't they better known? why aren't they out in being used? why aren't people being treated? that is the question you need to be asking. and i think there are some obvious reasons for that. i personally bang part of it is the medical profession. ..
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to treat all these veterans we have got coming back and the rest of the population. >> i want to second up and take it further in that if you go to see a physician for a heart transplant and they give you the jarvik one that was created 20 years ago in louisville you would live for about two minutes and that doctormacdoctormac k would be held for malpractice. they are expected to stay to standard care current with the research. why is mental health not held to the same standard of care by
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state-by-state by state and they are allowed to practice using techniques that were created 100 years ago? that would be the question i would ask. >> i would add to that is because mental health is undervalued by our society so every tuesday we have a disposition meeting in my clinic and i have 10 to 15 people that have called that don't have health insurance. they don't -- or they have medicare or medicaid but the patients are often not enrolled because the reimbursement makes it so that the paperwork probably surmounts the amount of payments and people don't enroll in the programs. i think it's part of the health care delivery issue and how we tell you mental health in this issue which again is a pervasive issue. >> we have a question in the back. we will pretend it's a microphone. >> is there a baseline that you guys have and if you are seeing
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someone for the first time and you don't know -- they haven't had treatment before of any kind and they haven't had evaluations before so you're kind of guessing that getting them back to normal you don't know what that was. i know there was a bill introduced recently that would introduce mental health evaluation as part of joining the service because there isn't one right now. with that establish a baseline in having an understanding of who they were and would that be a helpful thing or do not work off of the baseline? >> i think it's helpful definitely to get concept about that individual but the important thing we have in many of these measures measures is a norm sample so when you create a good measure, caution good you actually base it on people who are healthy and then those who are not so that you know what healthy should look like across a very large norm sample. i think part of the problem is some measures that people like
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to use in society were captured on such a small norm sample that it's not ethnic a gender diverse that you don't even know what healthy looks like on that measure. that's why it's so critical that we have good assessment to be able to show that. >> if i go to a hospital and see a doctor when i'm having chest pains he's going to take my blood is one of the first things he does. based on the presence or nonpresence of something called troponin he's going to say you had a bad sandwich or you are having a heart attack. we don't have any blood biomarkers. we can't even -- we don't even have an accepted imaging diagnosis of dramatic brain injury get mris are constantly being used but they are not accepted by the fda. you will cause the problem up here. you got so frustrated in 2007 you said anybody who gets a diagnosis of post-traumatic stress gets 50% disability. if all you have is a 20 question
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test to ask somebody and if you all look about 50% disability looks like from the va to somebody who leads the service you have created my numbers that i show you sometimes i believe are inflated because there are some people who know how to answer those 20 questions and they want the disability more than they want other things. now that's a small percentage of the population but it is a real frustration for commanders because commanders are having a rough time sometimes telling who is really sick and who is trying to play the game. >> we have about one and a half minutes left because i've been told we have a hard stop at 1:30. does someone have a one and a half minute question? very love. >> the culture of the military is changing and these people coming home feel like it's okay to get help and talk about it right away before the problems
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become exacerbated to the point they might not even need all of these plans but let's just go to therapy right away and start talking about what our issues were and what their experiences were instead of feeling like that could be a black mark on their resume. >> i believe the military has made huge strides. i really do. i used to come up here and often i had to testify. i was beaten up over military suicides in they are a horrible thing. we saw the suicide rate double from 2001 to 2008. it doubled not doubt that it reached a civilian average is what it did. it doubled from being half the civilian average. we were up here talking about 349 suicides in 2012 and 38,000 americans committed suicide. 38,000 americanamerican s. now if that is the national health problem i don't know what
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is. and 170,000 were hospitalized and received treatment because they failed a suicide attempt. those are huge dollars and this town seems moved by dollars. i would think we would start to look at that in the general population. >> i was second that we have thousands of therapist that have been trained on dod dollars to provide these treatments both at home and downrange and other places but i can also tell you one of the number one predictors of who does not go want to develop post-traumatic stress after an event is positive social support. someone to provide someone with a nonjudging nonblaming nonshaming environment. not why did you wear that dress? why were you driving that car? why were you doing x, y or z but will listen to you and if we can get that out of the public to provide the to provide an environment then we may not even need us a month later or 10 years later.
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>> one that optimistic note let's thank the panel. [applause] thank you and thanks again to the foundation and congressman thank you for staying.
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>> the wonderful thing about the gulf coast is its it's i think so underappreciated and that's good because it gives us a lot to write about. if we were in new york or san francisco or chicago those cities and places are also well-known in the horse new york is the capital but here in the gulf coast we tend to think of from texas to the florida panhandle. there really is a pan gulf sensibility. you have this similar environment similar types of trees live folks palm trees sandy soil salts in the air. the gulf of mexico of course nurses and supplies us with wonderful seafood. estuaries and rivers in places like mobile bay are wonderfully rich in tradition and culture. there have been books and memoirs and so forth in and around all these things for
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hundreds of years so it's an extraordinarily rich subject to take and course along comes the oil spill in 2010 where all of a sudden we are at center stage and people are beginning to look at the gulf coast and think wow what's it like they are or what moves them or we didn't know we got so much of our oil and gas from there so the nation became tuned in to how important the gulf is.
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the top chinese general urged the u.s. to be objective about a dispute between china and vietnam over a drilling rig in the south china sea. the situation has fueled vietnamese protests concerning territoriterritori al disputes between the two countries read the general that today with joint chiefs of staff chairman martin dempsey before speaking to the press. this is just under an hour. >> good afternoon. as you may know general fang to
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my left invited me to china a little more than a year ago where we candidly discuss many areas in which we share common interests. [speaking chinese] >> he was a tremendous host and i really appreciated the opportunity to meet with him in china. [speaking chinese] >> while there i met many fine young servicemen and women and the people's liberation army as i've traveled about the country. [speaking chinese]
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c. i invited general fang to the united states this year twos reciprocate on his hospitality and more importantly to continue to build on the relationship that we began last year. [speaking chinese] >> today we continued our conversation on our military-to-military relationship focused on further understanding one another and deepening cooperaticooperati on between our armed forces. >> all while managing our differences. [speaking chinese]
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to this end we have invited china to train with us for the first time at this year's ram of the pacific naval exercise. [speaking chinese] >> rimpac as we call it fosters and sustains collaborative relationships which of course help avoid miscalculations and prevent conflict. [speaking chinese] >> the global maritime environment is simply too large and too complex for any one nation. [speaking chinese]
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>> we also discuss the tensions in the south china sea and how provocative actions can lead to confrontation. [speaking chinese] >> these issues need to be resolved through dialogue under international law. [speaking chinese] >> we had a refreshingly frank and open discussion on our mutual concerns and different opinions about the east china sea. [speaking chinese]
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>> as well as the destabilizing effects in our view of north korean actions. [speaking chinese] >> yes we discussed last year
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[speaking chinese] see the next working group meetings will take place later this year. >> also general fang and i agreed to continue to working towards a teleconferencing capability between us and hopefully achieving out by this fall. [speaking chinese]
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>> all of these initiatives intended to continue to build a positive relationship to help us manage risk and reduce the chance of misunderstanding. [speaking chinese] >> last evening at the national defense university i welcome the general fang to washington d.c. and he spoke eloquentleloquentl y and what he said was this. together we will strive for a common security and a common prosperity. [speaking chinese]
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>> i would like to thank general fang and his delegation for coming to meet with us in the united states and i look forward to our deepening efforts. [speaking chinese] >> general fang. >> translator: dear friends from the press. good afternoon. [speaking chinese] >> translator: as you know i am paying an official visit to united states by the invitation of general dempsey. [speaking chinese]
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[speaking chinese] >> translator: this visit it's designed to implement important consensus by president she xiaoping and president obama for billing a new model of china-u.s. relationship based on mutual respect and willing cooperation. it's also our goal to advance the new model of china-u.s. military relationship along a sound and stable track and it's very important that we should all abide by the principle of
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nonconflict and on confrontation. [speaking chinese] >> translator: at present the china-u.s. bilateral relations and military relationship has reached an important historical stage and this context is very important to further our bilateral ties and military relations. [speaking chinese] >> translator: the united states is making great input in this and general dempsey has made thoughtful arrangements. i thank you for that.
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[speaking chinese] >> translator: this morning general dempsey and i held a large-scale meeting and a one-on-one meeting as well in which we exchanged constructive use on a number of important issues. we discussed our military relationship and our bilateral relationship our cooperation on counterterrorism and counter piracy. we talked about the islands and the current situation in the south china sea. [speaking chinese]
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>> translator: we agreed on many issues. just to name a few to carry out substantive consultation establishing a mechanism for mutual notification of major military activities and devising standards of behavior for air and sea military safety on the high seas to conduct more humanitarian assistance and
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disaster relief to exercise. to establish the counterpart dialogue between the two strategic lending departments. to continue advancing the army to army dialogue mechanism. to upgrade the defense telephone link between general staff and the joint chiefs of staff into a secured video teleconference system. and to explore the possibility of conduct ring joint exercising training in the country. [speaking chinese] [speaking chinese]
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>> translator: this morning i had a chance to have a meeting with relatives of general stillwell and mr. wynyard at flying tiger veteran. we would like to underscore that we will remember the contributions they have made to china-u.s. friendship and fighting against fascism. i believe it's important to keep in mind that we must defend what we have achieved in the second world war and prevent the arrival of militarism. also today i'm bringing with me our military archive that leads to a tragic loss of a flying tiger veteran mr. james frowned and i've turned it over to general dempsey. [speaking chinese]
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[speaking chinese] >> translator: at present china in the united states are actively building the new model according to the consensus of our presidents. it's not easy for our relationship to take one step after another to reach where it is today. and our military relationship is showing a positive momentum which would benefit the chinese and american people and help to secure the peace, stability and prosperity of the region and the world. so before i conclude may i
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suggest that we need to cherish what we have tilts through hardship to avoid new disturbances and impacts moving forward unswervingly. [speaking chinese] [speaking chinese] >> translator: and i would like also to hope that the united states could hold an objective view on the issues of the south china sea and the east china sea because we believe the
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ones that are provoking those issues in the south china sea is not china but a certain country that are 10 -- attempting to gain their own entrance because they believe that china is now a developing economy and the united states is adopting this rebalancing strategy. [speaking chinese] >> translator: i believe it's very important that we view those issues in an objective manner because if we do not do that there is the possibility that these issues could affect or disturb the relationship
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between the two countries and two militaries which actually i believe serve the broader interest of oath nations. thank you. >> ladies and gentlemen we have time for questions today. [speaking chinese] >> my question is on vietnam first for general fang. as the pla to finding the oil rig for the long-term or did the daily protests in vietnam is china ready to pull the rig back and take steps to de-escalate and lastly you spoke about the asia pivot. do you think u.s. efforts to deepen military ties in the region are emboldening hanoi and emboldening u.s. allies and for general dempsey could you please
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be explicit when you spoke about provocative actions in your opening remarks. do you believe china's behavior is an issue with vietnam has been provocative and china should -- protests in vietnam and did you call on china to pull back and do you risk of conflict in the east and south china sees increasing? [speaking chinese] [speaking chinese]
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[speaking chinese] [speaking chinese] [speaking chinese]
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[speaking chinese] [speaking chinese] secondly, the related countries in the south china sea region have drilled actually many oil wells in south china see, but china has never drilled even one. for the single fact we can see how much restraint china has
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exercised. ask the purpose of the restraint is to keep -- maintain the stability of the south china sea region. we have -- enjoyed putting aside disputes but while china is held in this position other nations are drilling oil wells in this region so that's the status quo, and i have to underscore it is under this brown we are conduct that exploration activity near the island. [speaking chinese]
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[speaking chinese] there are, it is a very normal behavior for china to conduct this drilling activity within our own territorial waterment and under that background vietnam has sent ships for disruption of that activity, and that is something that we are not able to accept. what we are going to do is to make sure the safety of the oil rig and ensure the operation keep going on. i think i've made my point quite clear, and i think it's quite
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clear to know that who is conducting normal activity and who is disrupting it. [speaking chinese] [speaking chinese] [speaking chinese]
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[speaking chinese] china actually has a very prudent attitude when it comes to similar activities as drilling an oil well. the location of this drilling activity has been carefully selected so that it would not -- we believe it would not raise too much disputes, but we don't quite understand why there are no comments from the outside when other nations are drilling, i assume, oil wells in the region, but when china starts to do the drilling, we instantly become a threat to the region. i think the external world should view this issue in
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objective and fair manner. i don't believe there's any problem for china to do this drilling activity within our own territorial water, and we will make sure that this well be successfully drilled and not be interferenced or disrupted by external factors. [speaking chinese] and actually this issue also needs to help from the press because if our friends from the press can view this issue in objective manner, it would help the ultimate solution or properly handling of the issue.
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in recent time the vietnam side has been contacting us in the multiple channels, and we will properly handle this issue of -- but only on the basis that we were strongly philadelphia -- fulfill this drilling activity. [speaking chinese] [speaking chinese]
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[speaking chinese] second part of the question i think is also very important for the americans, basically rebalancing strategy. we notice the american position which has been it -- it rate -- itrated many times -- the fact is our neighboring countries -- some of our neighboring countries used this did something we believed were not supposed to do and stir up the problems which actually make the south china sea and east china sea not so calm as before.
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[speaking chinese] another example is the japan's purchasing of the island. we take this as a drama and it also took place an the u.s. rebalancing strategy, and japan wanted to take the islands as japan's, and this is michigan that we can -- this is something we can never agree. [speaking chinese]
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a we have always been holding the position that the disputes over the islands should be put aside and we insist that position and principle and in the past 40 years, the islands and the east china sea has remained calm but the japanese actions as has make this region not calm as before, and the same situation took place in the south china sea as well. [speaking chinese]
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as we all know that 15 years ago, the philippines grounded a military ship on the reef, and it made the commitment upon this to china that it will tow away the military ship but it did not fulfill that commitment but rather left the ship on the reef for 15 years, and now the philippines are trying to reinforce the ship and make it a permanent facility, and we see the purpose of that behavior as something to attempt to take the reef as a reef of philippines. [speaking chinese]
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[speaking chinese] cheaps chinese [speaking chinese]
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>> and this behavior also make the south china sea not calm as it was before. i've said quite a lot, and i think i've made my point clearly that all these issues, i don't believe the responsibility lie on the chinese side. we always propose to adopt a policy of putting aside disputes and achieve common exploitation. by doing that we hope related nations can share resources of the south china sea, but certain countries believe that china would now focus on our economic developments and are trying to maintain the window of the strategic opportunity, therefore they believe it is opportunity for them to make the provocation, but we're not afraid of that. we do not make trouble. we do not create trouble. but we are not afraid of trouble. in matters, issues, that relates
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to sovereignty, territorial integrity, our attitude has been firm. we can fulfill what we have said, and i want to underscore finally that for the territory which has passed down by our ancestors into the hands of our generation, we cannot afford to lose an inch. thank you very much for your patient. now i turn the floor to you. >> no, sir. thank you for the time to formulate my answer. it was a good one, right? >> look, out of respect for my guest, i won't share with you exactly what we said to each other but i will speak to the issues. [speaking chinese]
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>> we talked about the fact we have to acknowledge there are disputes, territorial disputes, that are in play here. [speaking chinese] we spoke about the fact that the use of military assets to resolve pursuits is provocative and does increase risk. [speaking chinese] >> we had a rich discussion about what exactly is the status quo and who has been seeking to change it.
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we spoke about second and third order effects because in an interesting way in this century, with the proliferation of information, it's not possible to contain issues in any particular domain, so issues in the maritime domain quickly become issues -- issues afloat quickly become issues ashore, as we have seen today in vietnam. [speaking chinese] >> we made note of the ongoing negotiations.
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[speaking chinese] >> and that was the answer that it took me time to formulate. [speaking chinese] >> okay. last question goes to -- [speaking chinese] [speaking chinese]
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>> i have to ask two questions goes to each gentlemen. the first question goes to general feng. in recent time the security situation in asia pacific has undergone complicated changes. a lot of hot spot and sensitive issues have attracted the attention of the world. general feng, what is your view on that? and general dempsey, given the current situation in asia pacific region, will be any adjustment wasn't the united states rebalancing strategy to asia pacific? thank you. [speaking chinese]
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i guess i will answer this round again. unfortunately no time to formulate my answer. i will take this question first. >> please. [speaking chinese] [speaking chinese] i think part of my answer was imbedded in my answer to the other question, but i will also make a few points here. the first is that i believe the asia pacific current situation
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is stable generally speaking, because we da not see wars in this region like wars taking place in other regions. [speaking chinese] and i would also believe that the relationship between china and united states and between our two militaries are very important in maintaining the peace and stability in the region. [speaking chinese]
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[speaking chinese] just as i stated in my opening remarks, that the two president of our countries have reached important consensus in bidding a new model of bilateral relationship and military relationship. the two countries and two militaries should not engage in conflicts or confrontation but rather base our relationship on mutual respect and cooperation. i think that actually this is the key to the peace and stability of the asia pacific. and i believe we can successfully do that. our relationship could become the cornerstone for maintaining
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the regional peace and stability. [speaking chinese] [speaking chinese] just as you said, there are certain unsafe and unstable factors within the region, but just as i put it in my answer to the previous question, i believe all those disputes or issues that are related to china are not provoked by china. [speaking chinese]
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there are, of course, certain natural disasters, accidents, or social mass issues within the region, but i don't think these are the major issues. i believe there are three major issues within the region. the first is north korea. [speaking chinese]
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[speaking chinese] north korea issue has always been the hot spot is in the asia pacific region, and china always holds this position of not nuclearization of the korean peninsula, and we are trying very hard to prevent any war or conflicts within the korean peninsula and we propose that related parties sit down to actively resume the six-party talk. [speaking chinese] the second issue i would say is the territorial disputes between japan and china, between
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japan and south korea and between japan and russia. this issue deserve the high importance of related sides because if this issue is not properly handled, it could cause instability of the region. [speaking chinese] i would reiterate our position on the diaoyu islands and there are certain disputes in the south china sea that also require us to properly handle.
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[speaking chinese] >> and before i conclude, may i underscore that china is a peace-loving country. we stick to peaceful developments and a defensive national defense policy. when cheng chui president chengg visited europe not long ago he stated china is a lion that has
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awakened but it's a peaceful, cordial, and civilized lion, and i firmly believe that a peaceful, stable and prosperous china will contribute to the regional peace and stability. i think i've finished my comments, you asked what would draw us into the pacific more deeply? i think there's things that we will do because we should be doing them and can be doing them, and in particular as we gain some capacity as 12 years of conflict in the middle east. [speaking chinese] [speaking chinese] >> why? well, freedom of navigation,
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access to free markets, stabilities, partners old and knew, and training. [speaking chinese] [speaking chinese] >> and we all respond to threats and most recently and notably is the threat posed from north korea in response to which we have deployed ballistic missile defense assets and other capabilities. so, because we can and should and we'll go because we have to. [speaking chinese]
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thank you, ladies and gentlemen. >> gentlemen, a question about the va? >> yes, sure. >> thank you very much. >> i think they want me to answer. >> yes. >> are you confident that the medical system can be fictioned under the current leadership. >> i am confident that general rick shinseki has the skills, attributes, the concept of duty. eat never -- never has walked away from a fight in his entire life. it's an enormous challenge. this is -- these challenges are very difficult, but i have confidence that his leadership will help the veterans administration through this. we have a huge stake in this, in this department. we recruit the young men and women who become veterans and we look forward to working with
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them to continue to make progress. [inaudible conversations] >> despite protests the fcc proposed new rules that could let internet service providers charge companies for faster delivery of content to users. that's next on c-span2. then president obama tapeds a dedication ceremony for the 9/11 memorial and museum in new york, and later, pentagon and state department officials testify about nigeria and give an update on the abduction of nigerian school girls, kidnapped last month by boca haram. secretary of state john kerry was in london for a

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